Pharmacological spasm provocation testing in 2500 patients: provoked spasm incidence, complications and cardiac events
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ORIGINAL ARTICLE
Pharmacological spasm provocation testing in 2500 patients: provoked spasm incidence, complications and cardiac events Shozo Sueda1 Received: 27 February 2020 / Accepted: 17 April 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Pharmacological spasm provocation tests such as acetylcholine (ACh) and ergonovine (ER) had been performed in the clinic. We retrospectively analyzed the incidence of provoked spasm, complications during testing and the cardiac events after these tests. From January 1991 and October 2018, we performed pharmacological spasm provocation tests in 2500 patients: 1810 ACh tests, 1232 ER tests, 542 both tests, and 310 ACh added after ER tests. ACh was injected in incremental doses of 20/50/100/200 μg into the LCA and 20/50/80 μg into the RCA. ER was administered as a total dose of 64 μg into the LCA and 40 μg into the RCA. When adding ACh after ER, the total dose was 50/80 μg into the RCA and 100/200 μg into the LCA. Positive spasm was defined as ≥ 90% stenosis and usual chest pain or ischemic ECG changes. Mean follow-up duration was 47.5 ± 29.9 months. Overall, provoked positive spasm was found in 1095 patients (43.8%). The incidence of positive provoked spasm during ACh testing was significantly higher than that during other tests (ACh: 48.7% vs. ER: 28.9%, Both: 24%, ACh added after ER: 33.5%, p 50%), triple-vessel disease, two-vessel disease with total occlusion, heart failure (New York Heart Association functional class III or IV), renal failure (creatinine > 2.0 mg/dl), if spontaneous spasm was observed or if isosorbide dinitrate was initially used to relieve spasm in the coronary artery tested. The definition of positive spasm, major complications and major cardiac event: We defined positive spasm as ≥ 90% transient stenosis and usual chest symptom or ischemic ECG changes. The degree of ST-segment depression was measured 80 ms after the J point. We considered a result to be positive when at least 1 of the following ischemic ECG changes was demonstrated during and/or after the ACh test: (1) ST-segment elevation of ≥ 0.1 mV in at least 2 contiguous leads; (2) ST-segment depression of 0.1 mV in at least two contiguous leads. We also considered negative U wave as positive ischemic ECG change. We defined major complications during pharmacological testing as death, acute myocardial infarction, VF, sustained or nonsustained ventricular tachycardia, shock, hypotension (
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